North Dakota Code 65-05-28 – Examination of injured employee – Paid expenses – No compensation paid if injured employee refuses to reasonably participate
An injured employee may select a health care provider of that injured employee’s choice to render initial treatment. Upon a determination that the injured employee’s injury is compensable, the organization may require the injured employee to begin treating with another health care provider to better direct the medical aspects of the injured employee’s claim. The organization shall provide a list of three health care providers who specialize in the treatment of the type of injury the employee sustained. At the organization’s request, the injured employee shall select a health care provider from the list. An injured employee shall follow the directives of the health care provider treating the injured employee as chosen by the injured employee at the request of the organization and comply with all reasonable requests during the time the injured employee is under medical care. Providing further that:
Terms Used In North Dakota Code 65-05-28
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- children: includes children by birth and by adoption. See North Dakota Code 1-01-18
- following: when used by way of reference to a chapter or other part of a statute means the next preceding or next following chapter or other part. See North Dakota Code 1-01-49
- Organization: includes a foreign or domestic association, business trust, corporation, enterprise, estate, joint venture, limited liability company, limited liability partnership, limited partnership, partnership, trust, or any legal or commercial entity. See North Dakota Code 1-01-49
- Person: means an individual, organization, government, political subdivision, or government agency or instrumentality. See North Dakota Code 1-01-49
- Process: means a writ or summons issued in the course of judicial proceedings. See North Dakota Code 1-01-49
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- written: include "typewriting" and "typewritten" and "printing" and "printed" except in the case of signatures and when the words are used by way of contrast to typewriting and printing. See North Dakota Code 1-01-37
- year: means twelve consecutive months. See North Dakota Code 1-01-33
1. An injured employee may not change from one health care provider to another while under treatment or after being released, without the prior written authorization of the organization. Failure to obtain approval of the organization renders the injured employee liable for the cost of treatment and the new health care provider will not be considered the attending health care provider for purposes of certifying temporary disability.
a. Any injured employee requesting a change of health care provider shall file a written request with the organization stating all reasons for the change. Upon receipt of the request, the organization shall review the injured employee’s claim and approve or deny the change of health care provider, notifying the injured employee and the requested health care provider.
b. Emergency care or treatment or referral by the attending health care provider does not constitute a change of health care provider and does not require prior approval of the organization.
2. Travel and other personal reimbursement for seeking and obtaining medical care is paid only upon request of the injured employee. All claims for reimbursement must be supported by the original vendor receipt, when appropriate, and must be submitted within one year of the date the expense was incurred or reimbursement must be denied. Reimbursement must be made at the organization reimbursement rates in effect on the date of incurred travel or expense. The calculation for reimbursement for travel by motor vehicle must be calculated using miles actually and necessarily traveled. A personal reimbursement requested under this subsection is a managed care decision under section 65-02-20, subject to the appeal process as provided for in section 65-02-20. Providing further that:
a. Payment for mileage or other travel expenses may not be made when the distance traveled is less than fifty miles [80.47 kilometers] one way, unless the total mileage equals or exceeds two hundred miles [321.87 kilometers] in a calendar month; b. All travel reimbursements are payable at the rates at which state employees are paid per diem and mileage, except that the organization may pay no more than actual cost of lodging, if actual cost is less; c. Reimbursement may not be paid for travel other than that necessary to obtain the closest available medical or hospital care needed for the injury. If the injured employee chooses to seek medical treatment outside a local area where care is available, travel reimbursement may be denied; d. Reimbursement may not be paid for the travel and associated expenses incurred by the injured employee’s spouse, children, or other persons unless the injured employee’s injury prevents travel alone and the inability is medically substantiated; and
e. Other expenses, including telephone calls and car rentals are not reimbursable expenses.
3. The organization may at any time require an injured employee to submit to an independent medical examination or independent medical review by one or more duly qualified allied health care professionals designated or approved by the organization. The organization shall make a reasonable effort to designate a duly qualified allied health care professional licensed in the state in which the injured employee resides to conduct the examination before designating a duly qualified allied health care professional licensed in another state or shall make a reasonable effort to designate a duly qualified allied health care professional licensed in a state other than the injured employee’s state of residence if the examination is conducted at a site within two hundred seventy-five miles [442.57 kilometers] from the injured employee’s residence.
An independent medical examination and independent medical review must be for the purpose of review of the diagnosis, prognosis, treatment, or fees. An independent medical examination contemplates an actual examination of an injured employee, either in person or remotely if appropriate. An independent medical review contemplates a file review of an injured employee’s records, including treatments and testing. The injured employee may have a duly qualified health care provider designated by that employee present at the examination or later review the written report of the allied health care professional performing the independent medical examination, if procured and paid for by that injured employee. Providing further that:
a. In case of any disagreement between allied health care professionals making an examination on the part of the organization and the injured employee’s allied health care professional, the organization shall appoint an impartial allied health care professional duly qualified who shall make an examination and shall report to the organization.
b. The injured employee, in the discretion of the organization, may be paid reasonable travel and other per diem expenses under the guidelines of subsection 2. If the injured employee is working and loses gross wages from the injured employee’s employer for attending the examination, the gross wages must be reimbursed as a miscellaneous expense upon receipt of a signed statement from the employer verifying the gross wage loss.
4. If an injured employee, or the injured employee’s representative, refuses to submit to, or in any way intentionally obstructs, any examination or treatment, or refuses to reasonably participate in medical or other treatments or examinations, the injured employee is medically noncompliant. If the organization determines an injured employee is medically noncompliant without good cause, the organization shall discontinue disability and vocational rehabilitation benefits. At any time the injured employee is medically noncompliant, efforts by the injured employee to come into compliance are not considered successful compliance until the injured employee has been compliant for a period of at least sixty days. If the period of medical noncompliance continues for sixty days following the date disability and vocational rehabilitation benefits are discontinued, or a second instance of medical noncompliance occurs without good cause, the organization may not pay any further disability and vocational rehabilitation benefits, regardless of whether the injured employee sustained a significant change in medical condition due to the work injury. The period of noncompliance must be deducted from the period for which compensation is payable to the injured employee.
5. If an injured employee undertakes activities, whether or not in the course of employment, which exceed the treatment recommendations of the injured employee’s health care provider regarding the work injury, and the health care provider determines the employee’s injury or condition has been aggravated or has worsened as a result of the injured employee’s activities, the organization may not pay benefits relative to the aggravation or worsening, unless the activities were undertaken at the demand of an employer. An employer’s account may not be charged with the expenses of an aggravation or worsening of a work-related injury or condition unless the employer knowingly required the injured employee to perform activities that exceed the treatment recommendations of the injured employee’s health care provider.